急性心肌缺血综合征中国地区现状调查

Clinical characteristics of acute ischemic syndrome in China

目的研究分析中国地区急性心肌缺血综合征病人的临床特点和治疗现状.方法此项研究为国际多中心关于急性心肌缺血综合征登记试验(OASIS)的一部分.采用填写加拿大心血管合作协会统一设计的病例记录表(CRF)的方法,自1999年4月开始,收集了各中心因急性心肌缺血入院病人的资料,记录了病人主要临床特征和院内事件.结果共注册急性心肌缺血综合征(包括不稳定心绞痛及非Q波心肌梗死)病人1509例,来自全国范围内34所医院.病人平均年龄62.3岁,其中男性62.2%,就诊时持续胸痛47.8%,心电图异常89.5%,入院诊断不稳定心绞痛91.3%,非Q波心肌梗死8.7%.住院期间溶栓3.3%,冠状动脉造影35.0%,经皮冠状动脉腔内成形术(PTCA)16.8%,冠状动脉旁路移植术(CABG)4.1%,应用硝酸酯制剂96.8%,抗血小板治疗95.5%.院内发生重要并发症18.8%,其中死亡1.2%,主要原因为严重心律失常或猝死.结论中国地区急性心肌缺血病人以不稳定心绞痛就诊居多.我国病人住院期间PTCA治疗率相对较高,CABG治疗率较低.院内死亡最主要的原因为严重心律失常或猝死.

OBJECTIVE: To analyse the characteristics and therapies of patients with acute ischemic syndrome in China. METHODS: This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinica l characteristics and in hospital events of the patients were recorded. RESULTS: Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction).The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch ) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in hospital major events was 18.8%, in cluding 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death. CONCLUSIONS: Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in hospital death is severe arrhythmias or sudden death.